Newsletter :: July 2006


Monthly Motivator

There is no greater joy nor greater reward than to make a fundamental difference in someone’s life!


Upcoming Conferences

DSI – Dysphagia Scene Investigators – Video Evidence – July 29, 2006 in Tyler, Texas (FREE)

Professional Imaging LLC is a Mobile MBSS company in East Texas, Houston, Austin, and San Antonio, not a part of DiagnosTEX, LLC. They have invited me as a guest speaker, please call their Corp office 1-866-675-MBSS to register or for any questions about the conference.

MBSS Workshop – The Truth behind the Fluoro – Bedford, TX – August 12, 2006 Registration form included. LIMITED SEATING


July Holiday – DiagnosTEX will observe Independence Day on Tuesday, July 4th. Please keep this in mind when scheduling your MBSS around that time. Thank you. We have veterans working for DiagnosTEX and we honor them as well as those who have sacrificed for our freedom! Have a safe & happy 4th of July!


New SLP Handout and Give -away

The new Handout this month is Treatment Strategies: Why do, how to do, what it does. Be sure to ask for your next time we see you! Be looking for you new DiagnosTEX bags! You must get one of these!


Why do you use DiagnosTEX for your mobile MBS provider of choice in DFW?

We have received some incredible feedback about our service. Thank you! You’re the reason we do what we do and LOVE what we do!!!!

  1. DiagnosTEX aspire to achieve the same standard of excellence in the care they provide for our residents as we demand of our own staff. The DiagnosTEX Team not only possesses the level of expertise to deal with the challenges that arise in our setting, but they have the passion it requires to resolve those issues unique to the geriatric population. I have confidence that the DiagnosTEX SLP will be able to collaborate with our treating SLP to devise a treatment plan to achieve the least restrictive outcome for our residents. Carmen, Regional Manager, DFW, TX
  2. I chose DiagnosTEX as my MBSS mobile service provider due to their competent staff and speedy attention. DiagnosTEX exceeds all of my expectations by anticipating my needs; providing ongoing education for my staff, patients, family members, and facility; and assisting with decision making. The personal attention one received from DiagnosTEX far exceeds that of any other local business. Christian, Plano, TX
  3. I always use DiagnosTEX for my MBSS needs because I can confidently tell my patients and their families that this team is the best at what they do. I can rely on the results and recommendations with 100% accuracy. My patients are almost always scheduled within 24 hours, and the courteous staff and friendly employees are a plus! Cyndy, Fort Worth, TX
  4. I have Supreme confidence in the DiagnosTEX staff in the high competence level for dysphagia issues. DiagnosTEX provides prompt service, Excellent clinical, physiological, and physical knowledge. It is ALWAYS about the patient–quality of life at any stage whether at the beginning of an illness or at the end. I appreciate their professional support and timely consults. Each SLP, Physician, and Tech is able to quickly assess the patient’s cognitive-linguistic abilities and engage the patient during the study. I have some difficulty pts. but not one has ever been agitated by a study. DiagnosTEX provides a full complex (but easy to read) MBSS report to verify and/or adjust swallowing protocol to ensure the LRD. Elizabeth, Haltom, TX
  5. I choose DiagnosTEX as my mobile MBSS mobile service provider because I can always count on quality swallow studies performed by top notch professionals who have been doing them for years. The SLP’s on board are always willing to help provide suggestions on how I can better help my patients or answer any questions regarding dysphagia. The entire staff (including the receptionists, doctors, and drivers) has always been a pleasure to work with! Jean, N. Richland Hills, TX


Dysphagia Tidbit – FEES vs. MBSS

The use of fiberoptic endoscopy to evaluate the pharyngeal stage of the swallowing is a procedure developed by Susan Langmore, Ph.D., Kenneth Schatz, M.A., and Nels Olsen, M.D. Parameters than can be evaluated include pharyngeal pooling, premature spillage, penetration/aspiration, and residue. The procedure is mildly invasive and is limited to the events immediately before the swallow and after the swallow event. With FEES, during the time of the swallow/airway closure, the swallow cannot be visualized, as the pharyngeal walls contract over the bolus it collapses the lumen over the endoscope (“whiteout phase”). Oral phases are only indirectly evaluated and no evaluation of the esophageal phase (Gerber, M., Vaeronneau, M., 2002, ASHA, 2002)). Risks can include: laryngospasm, reaction to anesthesia, nosebleed, vasovagual/cardiac response. Contraindications: FEES are not indicated for patients with movement disorders, those who can not tolerate endoscopy, severe cognitive deficits, or history of bronchospasm or laryngospasm (Carrau, R., Murray, T., 1999). Indications for FEES: 1) problematic positioning, 2) MBSS is unavailable, 3) concern about radiation exposure, and 4) need to assess fatigue or swallow status over an entire meal.

Indications for an MBSS over FEES (Langmore et. al., 1996)

1) Esophageal phase problem suspected or need to be screened

2) Globus complaints

3) Vague symptomology noted at bedside

4) Need to verify aspiration of liquids during the swallow

5) Need to get impression of the amount of aspiration.

MBSS is necessary to determine “WHEN” penetration or aspiration is occurring. An MBSS provides more information about the oral phase dynamics, coordination of oropharyngeal movements, posterior tongue movement and apposition with the posterior pharyngeal wall, hyolaryngeal elevation, aspiration DURING the swallow, UES opening, esophageal phase dynamics, and evaluation of the effortful swallow technique and the Mendelsohn maneuver (Langmore & McCulloch, 1997). The MBSS remain the pre-eminent method to view the oral, pharyngeal, and esophageal phase in real time and to diagnose the underlying cause(s) for the symptoms of aspiration and penetration, as it also allows visualization of the pharyngeal phase while compensatory strategies are tested for their ability to increase swallowing safety and efficiency. Currently, no other technology has this versatility (Lewis, K., Liss, J., Sciortino, K., 2004). SLP’s should be aware of current research that continues to support the efficacy of the MBSS and its overall cost efficiency against inpatient hospital costs for the management of pneumonia or pulmonary complications secondary to aspiration (Lewis, K., Liss, J., Sciortino, K., 2004). Call DiagnosTEX for diagnosis of your dysphagia patients!